Citation Nr: 9737406
Decision Date: 11/06/97 Archive Date: 12/05/97
DOCKET NO. 92-07 213 DATE NOV 06 1997
On appeal from the Department of Veterans Affairs (VA) Regional
Office (RO) in San Juan, Puerto Rico
THE ISSUE
Entitlement to service connection for occlusion of the inferior
temporal branch vein of the right eye.
REPRESENTATION
Appellant represented by: N. A. V., Attorney
WITNESSES AT HEARING ON APPEAL
The veteran and his spouse
ATTORNEY FOR THE BOARD
Ripley P. Schoenberger, Counsel
INTRODUCTION
The veteran served on active duty from February 1956 to December
1959.
This particular appeal arose from a January 1989 rating decision by
the RO. In April 1993, the Board of Veterans' Appeals (Board)
remanded the case for development of the record. At that time the
issues were entitlement to service connection for a low back
disorder and service connection for disability of the right eye.
Subsequently, in a rating decision of April 1994, the RO granted
service connection and assigned a 20 percent rating for a lumbar
spine disability.
In June 1995, the case was returned to the Board. In July 1995,
the Board remanded the case for development of the record with
respect to the issue of service connection for a right eye
disorder.
By rating decision of June 1996, the RO increased the evaluation
for the serviceconnected low back disorder to 60 percent disabling,
and granted service connection for rhinitis. By a rating decision
of June 1997 the RO granted a total rating based on individual
unemployability due to service-connected disabilities.
While numerous other issues have been the subject of adjudicative
actions in the recent past, the Board finds that the only issues
appropriate for review by the Board at this time is that as stated
on the preceding page. The other issues are referred back to the
RO for any indicated development based on actions taken by the
veteran.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran maintains that the occlusion of the right inferior
temporal branch vein is due to the trauma he sustained in an
automobile accident in service.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A. 7104
(West 1991 & Supp. 1997), has reviewed and considered all of the
evidence and material of record in the three volumes of the
veteran's claims file. Based on its review of the relevant
evidence in this matter, and for the following reasons and bases,
it is the decision of the Board that the preponderance of the
evidence is against the claim of service connection for the
occlusion of the inferior temporal branch vein in the right eye.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable disposition
of the veteran's appeal has been obtained.
2. The veteran's occlusion of the inferior temporal branch vein
in the right eye is shown to have been manifested many years after
his period of active military service.
3. The veteran's currently demonstrated right disability is not
shown to be the likely result of any disease or injury sustained
while he was in service.
CONCLUSION OF LAW
The veteran's occlusion of the inferior temporal branch vein of the
right eye is not due to disease or injury which was incurred in or
aggravated by service. 38 U.S.C.A. 1131, 5107, 7104 (West 1991 &
Supp. 1997); 38 C.F.R. 3.102, 3.303 (1996).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
1. Background
The service medical records show that on the veteran's induction
examination his vision was 20/20, bilaterally. In April 1957, he
was seen by an optometrist for complaints of burning of his
eyelids. His vision was 20/20, bilaterally. An ophthalmoscopic
examination was negative. The diagnosis was that of
conjunctivitis. In February 1958, he complained of occasional pain
in his eyes. His vision was 20/20, bilaterally; examination of the
fundi was negative. He was advised to use sunglasses. On the
discharge examination, performed in February 1959, his vision was
20/20, bilaterally. He reported that he had been involved in an
automobile accident in 1954.
On a VA examination, performed in September 1960, the veteran's
vision was 20/20, bilaterally. His pupils were equal and round,
and reacted to light and accommodation.
VA outpatient treatment records, dated in June 1984, show that the
veteran reported that he had blurred vision in his right eye which
had appeared abruptly. After examination, the diagnosis was that
of an inferior temporal branch vein occlusion of the right eye. He
was referred for workup for hypertension and diabetes mellitus. In
July 1984, it was reported that the veteran's blood pressure was
noted to be 150/100. In June 1987, it was reported that the vision
in the veteran's right eye was 20/50 and the vision in his left eye
was 20/20.
At a personal hearing, held at the RO in November 1989, the veteran
stated that he had undergone laser treatment for his right eye, but
his vision was still not good enough for him to drive at night.
In an undated note, a private physician reported that the veteran
had no history of systemic disease, but a history of trauma to the
face in 1953. The doctor indicated that the branch vein occlusion
could be related to that facial trauma.
In a September 1990 statement, a private physician reported that
right eye branch vein occlusion might be related to trauma suffered
in the same eye.
In February 1995, a VA examiner indicated that the veteran's
current right eye disability was the result of retinal vein
vascular disease suffered in 1984 and that it was improbable that
there was a cause and effect relationship between the trauma in
1953 and his eye disease.
On a VA examination, conducted in October 1995, the veteran
reported that he had sustained trauma to his right eye in an
accident in 1953 and had a history of vein occlusion. He also
reported a history of laser surgery to the right eye. The vision
in the veteran's right eye was corrected to 20/30, and the vision
in his left eye was corrected to 20/20. The conjunctive and cornea
were clear and the anterior chambers were quiet. The irises were
intact. Examination of the fundus revealed laser marks at the
inferior branch of the retinal vein. There was no evidence of
revascularization. The diagnosis was that of old branch vein
occlusion of the right eye, refractive error, and early senile
cataracts of both eyes. On a VA ophthalmological examination,
conducted in June 1996, the veteran reported that he had suffered
a hemorrhage in his right eye in 1982 and 1983 and that he had been
in a motor vehicle accident in 1953. His corrected visual acuity
was reported as 20/40 in the right eye and 20/20 in the left eye.
The conjunctiva and cornea were clear. The irises were intact, and
the lenses were clear. Examination of the fundus revealed laser
marks in the right eye. The diagnoses were those of old branch
vein occlusion of the right eye and refractive error. The examiner
opined that branch vein occlusion in the right eye was not
associated with trauma 30 years previously and that a branch vein
occlusion was found in patients who had hypertension, diabetes
mellitus or a history of glaucoma. There was no evidence of
secondary glaucoma in the right eye.
In a December 1996 document, it was noted that a private physician
had stated that, since there was no history of systemic disease and
ocular branch vein occlusion was almost always associated with
systemic diseases such as hypertension, diabetes mellitus or high
cholesterol, a causative relationship between trauma and the
occlusion of the branch vein of the right eye could not be ruled
out.
Analysis
The law provides that service connection may be granted for
disability resulting from disease or injury incurred in or
aggravated by active military service. 38 U.S.C.A. 1110, 1131 (West
1991 & Supp. 1997). However, the preliminary requirement for
establishing service connection to any VA benefit is that the
appellant submit a claim which is sufficient to justify a belief by
a fair and impartial individual that the claim is well grounded. 38
U.S.C.A. 5107(a) (West 1991 & Supp. 1997). The United States Court
of Veterans Appeals (Court) has defined a well-grounded claim as "a
plausible claim, one which is meritorious on its own or capable of
substantiation." Such a claim need not be conclusive, but only
possible, to satisfy the initial burden of 5107. Murphy v.
Derwinski, 1 Vet.App. 78, 81 (1990).
Evolving case law promulgated by the Court has resulted in what is
in effect a threeprong test to determine whether a claim is well
grounded. There must be competent evidence of a current disability
(i.e., a medical diagnosis), of incurrence or aggravation of a
disease or injury in service, and of a nexus between the injury or
disease in service and the current disability. See Rabideau v.
Derwinski, 2 Vet.App. 141 (1992); Grottveit v. Brown, 5 Vet.App. 92
(1993); Grivois v. Brown, 6 Vet.App. 136 (1994); Caluza v. Brown,
7 Vet.App. 498 (1995). To be well grounded, a claim must be
supported by evidence that suggests more than a purely speculative
basis for an award of benefits, medical evidence is required, not
just allegations. Tirpak v. Derwinski, 2 Vet.App. 609 (1992);
Dixon v. Derwinski, 3 Vet.App. 261 (1992).
The Board finds that the claim for service connection for occlusion
of the inferior temporal branch vein in the right eye is well
grounded under these requirements in that there is medical evidence
that the claimed right eye disability could be due to trauma
sustained in service.
However, after a review of the evidence of record, the Board is of
the opinion that a preponderance of the evidence does not support
this position advance by and on behalf of the veteran. The
evidence clearly establishes that the occlusion of the inferior
temporal branch vein of the right eye was clinically manifested
many years after the veteran's period of active military service.
The competent evidence of record includes opinions from both
private and VA doctors to the effect that the claimed disorder is
usually associated with systemic diseases, such as hypertension,
diabetes mellitus or glaucoma. While one of the private physicians
has stated that the branch vein occlusion might be due to trauma
sustained in service, he has provided no reasons or medical bases
for this opinion. The other private doctor felt that the claimed
relationship could not be ruled out because the there was no
evidence of systemic disease. But the Board notes that, in the
veteran's case, the medical records prepared contemporaneously with
the treatment in 1984 quite clearly suggest the presence of
hypertension. Significantly, the VA examiner expressly that the
claimed disability was not related to the trauma in service.
The Court has held a medical opinion that a veteran's disability
might or might not be due to a certain cause was speculative in
nature. Tirpak v. Derwinski, 2 Vet.App. 609 (1992). Thus, the
Board finds the statements from the private physicians in this case
to be speculative and to lack probative value when considered in
light of the opinion rendered by the VA examiner. Since the Board
finds the statements from the VA physician more persuasive and
consistent with the medical evidence of record on the question of
medical causation, service connection is denied.
ORDER
Entitlement to service connection for occlusion of the inferior
temporal branch vein in the right eye is denied.
STEPHEN L. WILKINS
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. 7266 (West 1991 &
Supp. 1997), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals within
120 days from the date of mailing of notice of the decision,
provided that a Notice of Disagreement concerning an issue which
was before the Board was filed with the agency of original
jurisdiction on or after November 18, 1988. Veterans' Judicial
Review Act, Pub. L. No. 100-687, 402, 102 Stat. 4105, 4122 (1988).
The date which appears on the face of this decision constitutes the
date of mailing and the copy of this decision which you have
received is your notice of the action taken on your appeal by the
Board of Veterans' Appeals.